By Debra Wood, RN, contributor Jan 20, 2020
more than 150 years, nurse anesthetists have provided anesthesia care in the
United States, and now certified registered nurse anesthetists (CRNAs), also
known as nurse anesthesiologists, safely administer to patients more than 49
million anesthetics annually.
As the new
decade begins, what trends are expected for CRNAs in 2020?
“It is a top priority for CRNAs to be able to practice at
the full scope of our education and training to service the public and provide
affordable and quality health care,” said Jose Castillo III, PhD, MS, CRNA,
APRN, president of the Florida Association of Nurse Anesthetists
Care is honoring all nurse anesthetists during National CRNA Week,
Jan. 19-25, 2020.]
CRNA scope of practice and
30 states, such as California, and the District of Columbia, allow CRNAs
independent practice, many other states, including Florida and South Carolina,
require physician supervision of CRNAs. But that is starting to change.
“A significant activity gaining traction among U.S.
lawmakers is allowing advanced practice registered nurses, such as CRNAs, to
practice at the full scope of their education and training,” said Melissa
Cooper, spokesperson for the American
Association of Nurse Anesthetists (AANA).
Greg Crawford, MSN, CRNA, president of the California
Association of Nurse Anesthetists, agreed, adding that with all of the
supportive research, he is seeing movement in the direction of CRNAs being
allowed “to practice to the full extent of their training.”
can be a physician or a dentist, not necessarily an anesthesiologist. For
example a CRNA in a plastic surgery center can be supervised by the plastic
surgeons, MDs or DOs, are governed by their scope of practice, and I, being a
CRNA, am governed by standards of practice, based on what the American Association
of Nurse Anesthetists put forth as standards,” Castillo said.
addition to administering general and spinal anesthesia, nurse anesthetists
also can place arterial lines, pulmonary-artery catheters and other lines and
administer nerve blocks.
also may offer pain management. The University of South Florida in Tampa and
Texas Christian University in Fort Worth, offer CRNA pain management fellowship
CRNA scope of practice becomes extremely important in rural settings, where
nurse anesthetists may be the sole anesthesia providers.
York, nurse anesthetists are working toward being recognized and licensed as a
CRNA, instead of practicing under their RN license, said Stephanie
Grolemund, BSN, MSN, CRNA, president of the New York State Association of Nurse
Centers for Medicare & Medicaid Services (CMS), in the Physician Fee
Schedule, recognized a CRNA’s ability to perform pre-anesthetic assessments in ambulatory
surgical centers. It also recognized Medicare Part B payments to CRNAs for
evaluation and management services.
“We are grateful and strongly
support CMS’ action, which promotes key regulatory efficiencies and
consistencies and adherence to standards in nursing practices,” said Kate
Jansky, MHS, CRNA, APRN, USA, LTC (ret), president of AANA, in a statement.
Executive order #13890, signed in October 2019, calls
for reforms to the Medicare program, including eliminating supervision
This will enable “CRNAs to provide patient care at the top
of their advanced education and training,” Grolemund said.
CMS gave state governors the authority to opt-out of a
hospital or ambulatory surgery center reimbursement requirement for physician supervision
of nurse anesthetists, in 2001. So far, 17 states have opted-out of the
supervisory requirement. These states are Alaska, California, Colorado, Iowa,
Idaho, Kansas, Kentucky, Minnesota, Montana, Nebraska, New Hampshire, New
Mexico, North Dakota, Oregon, South Dakota, Washington and Wisconsin.
is confusing,” Crawford said. “It is a billing issue, not a practice issue.”
American Society of Anesthesiologists has issued a statement, stating it
strongly opposes gubernatorial opt-outs, citing safety concerns. But multiple
studies do not bear that out.
“Published research shows no
difference in outcomes of care with physician supervision, and the increase in
cost for unnecessary supervision is borne by patients and facilities,” said Jansky,
in a statement.
for practicing as a CRNA is changing, and starting in 2025, all newly minted
CRNAs will need a doctoral degree. The move is consistent with the educational
preparation of other healthcare professionals, such as pharmacists and physical
the Bar in CRNA Education: What the 2025 Deadline Means.
Graduates of nurse anesthesia educational programs must pass
the National Certification Exam before they can practice.
Opioid alternatives are a trend for CRNAs in 2020, Grolemund
The State of Florida is one of a few states requiring an
anesthesiology provider to discuss nonopioid options with the patient prior to
a procedure. Those options may include nerve blocks or the use of gabapentin,
acetaminophen, lidocaine, ketorolac or other medications given intravenously for
“Patients can refuse opioids, and we, as anesthesia
providers, can give alternatives during the procedure,” Castillo said.
“Patients go home more alert, with no nausea and vomiting. At the same time,
patients come out with better outcomes from anesthesia.”
Patients seem familiar with CRNAs, who will take time to
talk with patients and tailor a plan to each individual’s needs.
“Most patients are more than happy to have a CRNA administer
their anesthesia,” Crawford said. “They understand we are advanced practice
nurses prepared to deliver anesthesia independently.”
for locum tenens CRNAs
As the demand for anesthesia care has grown, so has the need
for CRNAs to fill temporary assignments as locum tenens. These jobs can be
full-time traveling jobs with supplied housing, or part-time assignments in
your own back yard. Locum CRNAs can choose when and where they work, and enjoy
a number of career and lifestyle benefits.
Search Dozens of Current CRNA Assignments